Cardioprotective effect of fimasartan, a new angiotensin receptor blocker (ARB), was evaluated in a porcine model of acute myocardial infarction (MI). Fifty swine were randomized to group 1 (sham, n=10), group 2 (no angiotensin-converting enzyme inhibitor [ACEI] or ARB, n=10), group 3 (perindopril 2 mg daily, n=10), group 4 (valsartan 40 mg daily, n=10), or group 5 (fimasartan 30 mg daily, n=10). Acute MI was induced by occlusion of the left anterior descending artery for 50 min. Echocardiography, single photon emission computed tomography (SPECT), and F-18 fluorodeoxyglucose cardiac positron emission tomography (PET) were performed at baseline, 1 week, and 4 weeks. Iodine-123 meta-iodobenzylguanidine (MIBG) scan was done at 6 weeks for visualization of cardiac sympathetic activity. Left ventricular function and volumes at 4 weeks were similar between the 5 groups. No difference was observed in groups 2 to 5 in SPECT perfusion defect, matched and mismatched segments between SPECT and PET at 1 week and 4 weeks. MIBG scan showed similar uptake between the 5 groups. Pathologic analysis showed similar infarct size in groups 2 to 5. Infarct size reduction was not observed with use of fimasartan as well as other ACEI and ARB in a porcine model of acute MI.
3-Iodobenzylguanidine ; Angiotensin II Type 1 Receptor Blockers/therapeutic use ; Angiotensin Receptor Antagonists/*therapeutic use ; Angiotensin-Converting Enzyme Inhibitors/therapeutic use ; Animals ; Anterior Wall Myocardial Infarction/*drug therapy/physiopathology ; Biphenyl Compounds/*therapeutic use ; Cardiotonic Agents/*therapeutic use ; Disease Models, Animal ; Echocardiography ; Fluorodeoxyglucose F18 ; Perindopril/therapeutic use ; Positron-Emission Tomography ; Pyrimidines/*therapeutic use ; Random Allocation ; Swine ; Tetrazoles/*therapeutic use ; Tomography, Emission-Computed, Single-Photon ; Valsartan/therapeutic use ; Ventricular Function, Left/*physiology

BACKGROUND AND OBJECTIVES: This study aims to investigate the clinical features, angiographic findings, and outcomes of younger Korean ST-segment elevation myocardial infarction (STEMI) patients. SUBJECTS AND METHODS: We analyzed major adverse cardiac events (MACE) in the Korea Acute Myocardial Infarction Registry from November 2005 to October 2010. The registered patients were divided into two groups; young age group (<65 years) and old age group (> or =65 years). RESULTS: The young age group included 5281 patients (age, 53+/-7.8 years), and the old age group included 4896 patients (age, 74.3+/-6.5 years). Male gender, smoking, family history, dyslipidemia, and metabolic syndrome were more frequently observed in the young age group than in the old age group (89.5% vs. 59.3%, p<0.001; 77.3% vs. 47.2%, p<0.001; 11% vs. 4.6%, p<0.001; 11.2% vs. 7.7%, p<0.001; 67.6% vs. 62.9%, p<0.001). Most of the young Korean adults with STEMI complained of typical chest pain (89.8%), and they had a shorter symptom-to-door time (12+/-53.2 hours vs. 17.3+/-132 hours, p=0.010). The young age group showed a favorable prognosis, which was represented by the MACE, compared with the old age group at one month (1.8% vs. 2.8%, p=0.028), six months (6.8% vs. 8.2%, p<0.001), and twelve months (10.1% vs. 11.9%, p=0.025). However, there was no significant difference in the adjusted MACE rate at one month {hazard ratio (HR) 0.95, 95% confidence interval (CI) 0.60-1.51, p=0.828} and twelve months (HR 0.86, 95% CI 0.68-1.10, p=0.233). CONCLUSION: Younger Korean adults with STEMI have clinical outcomes similar to old aged patients, and therefore, they should be treated intensively like the elderly patients.
Adult* ; Aged ; Chest Pain ; Dyslipidemias ; Humans ; Korea ; Male ; Myocardial Infarction* ; Prognosis ; Smoke ; Smoking ; Young Adult

OBJECTIVE: The aim of this study is to compare the clinical benefits between high-intensity and low-to moderate-intensity statin therapy in patients with acute myocardial infarction (AMI). METHODS: A total of 1,230 patients in the Korea AMI Registry (KAMIR) were enrolled. Patients were divided into two groups according to the dosage of statin for the secondary prevention after AMI. The primary endpoint was composite of major adverse cardiac events (MACEs) including cardiac death, non-fatal MI, repeat revascularization during the 12 months of clinical follow-up. RESULT: The primary endpoint occurred in 101 patients (11.3%) from the low-to moderate-intensity statin group and 45 patients (13.4%) from the high-intensity statin group. The cumulative incidence of MACEs during 12-month follow-up was not significantly different between the two groups (p=0.323). After multi-variate analysis, MACEs-free survival rate was not significantly different between the two groups. CONCLUSION: High-intensity statin therapy did not show additional clinical benefit over low-to moderate-intensity statin therapy after AMI.
Death ; Follow-Up Studies ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors* ; Incidence ; Korea ; Myocardial Infarction* ; Secondary Prevention ; Survival Rate

We compared clinical characteristics, management, and clinical outcomes of nonagenarian acute myocardial infarction (AMI) patients (n=270, 92.3+/-2.3 yr old) with octogenarian AMI patients (n=2,145, 83.5+/-2.7 yr old) enrolled in Korean AMI Registry (KAMIR). Nonagenarians were less likely to have hypertension, diabetes and less likely to be prescribed with beta-blockers, statins, and glycoprotein IIb/IIIa inhibitors compared with octogenarians. Although percutaneous coronary intervention (PCI) was preferred in octogenarians than nonagenarians, the success rate of PCI between the two groups was comparable. In-hospital mortality, the composite of in-hospital adverse outcomes and one year mortality were higher in nonagenarians than in octogenarians. However, the composite of the one year major adverse cardiac events (MACEs) was comparable between the two groups without differences in MI or re-PCI rate. PCI improved 1-yr mortality (adjusted hazard ratio [HR], 0.50; 95% confidence interval [CI], 0.36-0.69, P<0.001) and MACEs (adjusted HR, 0.47; 95% CI, 0.37-0.61, P<0.001) without significant complications both in nonagenarians and octogenarians. In conclusion, nonagenarians had similar 1-yr MACEs rates despite of higher in-hospital and 1-yr mortality compared with octogenarian AMI patients. PCI in nonagenarian AMI patients was associated to better 1-yr clinical outcomes.
Acute Disease ; Age Factors ; Aged, 80 and over ; *Angioplasty, Balloon, Coronary ; Electrocardiography ; Female ; Hospital Mortality ; Humans ; Male ; Myocardial Infarction/*diagnosis/mortality/therapy ; *Percutaneous Coronary Intervention ; Proportional Hazards Models ; Registries ; Treatment Outcome

BACKGROUND AND OBJECTIVES: Prehypertension according to JNC7 is common and is associated with increased vascular mortality. The importance of management in high-normal blood pressure (BP) is underemphasized. SUBJECTS AND METHODS: We analyzed major adverse cardiac events (MACEs) in the Korea Acute Myocardial Infarction Registry in normal BP (group I) and high-normal BP (group II) patients. RESULTS: Among 14871 patients, 159 (61+/-12.3 years, 122 males) satisfied the study indication. Six-month and one-year clinical follow-up rate was 88.9% and 85.8%, respectively. Group I had 78 patients (60.9+/-12.4 years). Group II had 81 patients (61.6+/-12.5 years). Demographics of patients were not different between groups. Treatment strategy was not different. Initial Thrombolysis in Myocardial Infarction flow grade 0 was less frequent in group II (n=32, 47.1%) than in group I (n=16, 21.9%) (p=0.001). Successful intervention rate was not different between group II (93.8%) and group I (97.1%) (p=0.590). Six-month MACE occurred in 3 patients in group I (4.4%) and 10 in group II (15.6%) (p=0.031). Compared with normal BP, the odds ratio for patients with high-normal BP was 1.147 (p=0.045, 95% confidence interval 1.011-1.402) for 6-month MACE. CONCLUSION: Even though high-normal BP patients had a better baseline clinical status, the prognosis was poorer than patients with normal BP. Therapeutic BP target goal for the patients with acute myocardial infarction should be <140/90 mm Hg, which is recommended in JNC7.
Blood Pressure ; Demography ; Emergencies ; Follow-Up Studies ; Humans ; Korea ; Myocardial Infarction ; Odds Ratio ; Prehypertension ; Prognosis

BACKGROUND AND OBJECTIVES: Recently, the prognostic value of N-terminal brain natriuretic peptide (NT-proBNP) in acute coronary syndrome has been demonstrated in many studies. However, NT-proBNP levels are influenced by various factors such as sex, age, renal function, heart failure severity, and obesity. NT-proBNP concentrations tend to decrease with higher body mass index (BMI). The aim of this study was to examine the influence of obesity on NT-proBNP as a predictive prognostic factor in acute myocardial infarction (AMI) patients. SUBJECTS AND METHODS: Using data from the Korea Acute Myocardial Infarction Registry (January 2005 to September 2008), 2,736 AMI patients were included in this study. These patients were divided into men (n=1,972, 70%) and women (n=764, 30%), and were grouped according to their BMIs. Major adverse cardiac events (MACE) during 1 year clinical follow-up were evaluated. RESULTS: NT-proBNP was significantly higher in lower BMI (p<0.001). Mean NT-proBNP levels of each obesity group were 2,393+/-4,022 pg/mL in the lean group (n=875), 1,506+/-3,074 pg/mL in the overweight group (n=724) and 1,100+/-1,137 pg/mL in the obese group (n=1,137) (p<0.01). NT-proBNP was an independent prognostic factor of AMI in obese patients by multivariative analysis of independent risk factors of MACE (p=0.01). CONCLUSION: NT-proBNP is lower in obese AMI patients than in non-obese AMI patients, but NT-proBNP is still of independent prognostic value in obese AMI patients.
Acute Coronary Syndrome ; Body Mass Index ; Brain ; Female ; Follow-Up Studies ; Heart Failure ; Humans ; Korea ; Male ; Myocardial Infarction ; Natriuretic Peptide, Brain ; Obesity ; Overweight ; Peptide Fragments ; Risk Factors

No abstract available.

The efficacy of low molecular weight heparin (LMWH) with low dose unfractionated heparin (UFH) during percutaneous coronary intervention (PCI) with or without glycoprotein (Gp) IIb/IIIa inhibitor compared to UFH with or without Gp IIb/IIIa inhibitor has not been elucidated. Between October 2005 and July 2007, 2,535 patients with ST elevation acute myocardial infarction (STEMI) undergoing PCI in the Korean Acute Myocardial Infarction Registry (KAMIR) were assigned to either of two groups: a group with Gp IIb/IIIa inhibitor (n=476) or a group without Gp IIb/IIIa inhibitor (n=2,059). These groups were further subdivided according to the use of LMWH with low dose UFH (n=219) or UFH alone (n=257). The primary end points were cardiac death or myocardial infarction during the 30 days after the registration. The primary end point occurred in 4.1% (9/219) of patients managed with LMWH during PCI and Gp IIb/IIIa inhibitor and 10.8% (28/257) of patients managed with UFH and Gp IIb/IIIa inhibitor (odds ratio [OR], 0.290; 95% confidence interval [CI], 0.132-0.634; P=0.006). Thrombolysis In Myocardial Infarction (TIMI) with major bleeding was observed in LMHW and UFH with Gp IIb/IIIa inhibitor (1/219 [0.5%] vs 1/257 [0.4%], P=1.00). For patients with STEMI managed with a primary PCI and Gp IIb/IIIa inhibitor, LMWH is more beneficial than UFH.
Acute Disease ; Aged ; Drug Therapy, Combination ; Female ; Hemorrhage ; Heparin/*therapeutic use ; Heparin, Low-Molecular-Weight/*therapeutic use ; Humans ; Male ; Middle Aged ; Multivariate Analysis ; Myocardial Infarction/epidemiology/mortality/*therapy ; Myocardial Revascularization ; Odds Ratio ; Platelet Glycoprotein GPIIb-IIIa Complex/*antagonists & inhibitors/metabolism ; Prognosis ; Registries

PURPOSE: There is still debate about the timing of revascularization in patients with acute non-ST-segment elevation myocardial infarction (NSTEMI). We analyzed the long-term clinical outcomes of the timing of revascularization in patients with acute NSTEMI obtained from the Korea Acute Myocardial Infarction Registry (KAMIR). MATERIALS AND METHODS: 2,845 patients with acute NSTEMI (65.6 +/- 12.5 years, 1,836 males) who were enrolled in KAMIR were included in the present study. The therapeutic strategy of NSTEMI was categorized into early invasive (within 48 hours, 65.8 +/- 12.6 years, 856 males) and late invasive treatment (65.3 +/- 12.1 years, 979 males). The initial- and long-term clinical outcomes were compared between two groups according to the level of Thrombolysis In Myocardial Infarction (TIMI) risk score. RESULTS: There were significant differences in-hospital mortality and the incidence of major adverse cardiac events during one-year clinical follow-up between two groups (2.1% vs. 4.8%, p < 0.001, 10.0% vs. 13.5%, p = 0.004, respectively). According to the TIMI risk score, there was no significant difference of long-term clinical outcomes in patients with low to moderate TIMI risk score, but significant difference in patients with high TIMI risk score (> or = 5 points). Conclusions: The old age, high Killip class, low ejection fraction, high TIMI risk score, and late invasive treatment strategy are the independent predictors for the long-term clinical outcomes in patients with NSTEMI.
Age Factors ; Aged ; Angioplasty, Transluminal, Percutaneous Coronary ; Female ; Fibrinolytic Agents/*therapeutic use ; Hemodynamics/drug effects ; Humans ; Male ; Middle Aged ; Multivariate Analysis ; Myocardial Infarction/*drug therapy/pathology/therapy ; Prospective Studies ; Thrombolytic Therapy/*methods

We sought to determine the prevalence of metabolic syndrome (MS) in patients with acute myocardial infarction and its effect on clinical outcomes. Employing data from the Korea Acute Myocardial Infarction Registry, a total of 1,990 patients suffered from acute ST-elevation myocardial infarction (STEMI) between November 2005 and December 2006 were categorized according to the National Cholesterol Education Program-Adult Treatment Panel III criteria of MS. Primary study outcomes included major adverse cardiac events (MACE) during one-year follow-up. Patients were grouped based on existence of MS: group I: MS (n=1,182, 777 men, 62.8+/-12.3 yr); group II: Non-MS (n=808, 675 men, 64.2+/-13.1 yr). Group I showed lower left ventricular ejection fraction (LVEF) (P=0.005). There were no differences between two groups in the coronary angiographic findings except for multivessel involvement (P=0.01). The incidence of in-hospital death was higher in group I than in group II (P=0.047), but the rates of composite MACE during one-year clinical follow-up showed no significant differences. Multivariate analysis showed that low LVEF, old age, MS, low high density lipoprotein cholesterol and multivessel involvement were associated with high in-hospital death rate. In conclusion, MS is an important predictor for in-hospital death in patients with STEMI.
Acute Disease ; Age Factors ; Aged ; C-Reactive Protein/analysis ; Cholesterol, LDL/blood ; Coronary Angiography ; Female ; Humans ; Male ; Metabolic Syndrome X/*complications/epidemiology ; Middle Aged ; Multivariate Analysis ; Myocardial Infarction/*complications/mortality/therapy ; Predictive Value of Tests ; Prognosis ; Treatment Outcome ; Ventricular Dysfunction, Left/complications/physiopathology